pediatric discharge against medical advice: experience from a nigerian secondary healthcare institution

abstract background and objective: often, discharge of children against medical advice has a negative effect on the well-being of the patient. to determine the prevalence of discharge against medical advice (dama) among hospitalized children and examine the reasons given by parents/guardians for such discharges. methods: a retrospective 2-year medical records audit of children aged one day to 15 years discharged against medical advice was carried out in a pediatric unit of a secondary health-care facility. results: the overall prevalence of dama was 6.3% while the prevalence among neonates was 7.5%, p>0.05. sixty-two (56.4%) of all cases were less than 12 months old with neonates accounting for 40 (64.5%) of the 62. the prevalence of dama was 2.8 times higher in male neonates compared to female neonates. thirty two (9.9%) of 322 male neonates compared to 8 (3.7%) of female neonates were dama odd ratio, or=2.8 95% confidence interval, ci= 1.26, 6.20). majority (65.4%) of the signatories to the discharge documents were the child’s fathers. in only 5.5% of cases were the child’s mothers the signatories. rate of re-admission was 13.6%. the commonest reason for dama in both neonates and older children was financial constraints. parental disagreement with planned treatment and/or investigations ranked second in the case of neonates. conclusions: dama is a common social pediatric health problem, especially among infants and has multifactorial etiology. socioeconomic factors, parental misjudgment of improvement and disagreement with treatment plan were found to have a significant bearing to its occurrence.